Left atrial intramural haematoma associated with mitral annular calcification.

Left atrial wall haematoma is a very uncommon entity, associated mainly to cardiac surgery, interventional procedures, or trauma. Spontaneous cases are supposed to be associated with left atrial wall pathology. We present a case of a 53-year-old male who was admitted for prolonged chest pain, with transthoracic and transesophagic echocardiography documentation of a left atrial mass in close proximity to a mitral annular calcification. Tissue characterization with cardiac magnetic resonance suggested the aetiology of the mass, which was confirmed histologically.

Disfunción sistólica aislada del ventrículo derecho en la esclerodermia / Isolated right ventricular systolic dysfunction in scleroderma

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Increased exercise capacity after surgically induced weight loss in morbid obesity.

OBJECTIVE: To investigate the effects of surgically induced weight loss on exercise capacity in patients with morbid obesity (MO). RESEARCH METHODS AND PROCEDURES: A prospective 1-year follow-up study was carried out, with patients being their own controls. A symptom-limited cardiopulmonary exercise stress test was performed in 31 MO patients (BMI > 40 kg/m2) before and 1 year after undergoing bariatric surgery. RESULTS: At 1 year after surgery, weight was reduced from 146 +/- 33 to 95 +/- 19 kg (p < 0.001), and BMI went from 51 +/- 4 to 33 +/- 6 kg/m2 (p < 0.001). After weight loss, obese patients performed each workload with lower oxygen consumption, heart rate, systolic arterial pressure, and ventilatory volume (p < 0.001). This reduced energy expenditure allowed them to increase the duration of their effort test from 13.8 +/- 3.8 to 21 +/- 4.2 minutes (p < 0.001). Upon finishing the exercise, MO patients before surgery were able to reach only 83% of their age-predicted maximal heart rate, and their respiratory exchange ratio was 0.87 +/- 0.06. After weight loss, those values were 90% and 1 +/- 0.08, respectively (p < 0.01). When we compared the peak O2 pulse corrected by fat free mass before and after surgery, no significant differences between the groups were found. DISCUSSION: After surgically induced weight loss, MO patients markedly improved their exercise capacity. This is due to the fact that they were able to perform the external work with lower energy expenditure and also to increase cardiovascular stress, optimizing the use of cardiac reserve. There were no differences in cardiac function before and after surgery.

[Cardiopulmonary function and exercise capacity in patients with morbid obesity]. / Función cardiopulmonar y capacidad de ejercicio en pacientes con obesidad mórbida.

INTRODUCTION AND OBJECTIVES: The effect of obesity on cardiac function is still under discussion. The objective of this study was to assess cardiopulmonary capacity in morbidly obese patients. Patients and method. A symptom-limited cardiopulmonary exercise stress test was carried out in 31 morbidly obese patients (BMI 50 9 kg/m2) and 30 normal controls (BMI 24 2 kg/m2. Cardiovascular function was evaluated using the oxygen pulse (oxygen uptake/heart rate). RESULTS: There were no differences in age, sex and height between both groups. During the effort the obese subjects presented greater oxygen uptake, heart rate, systolic arterial pressure and minute ventilation and shorter test duration than control group (14 3 vs 27 4 min; p < 0.001). Oxygen pulse values were higher in obese patients. However, after oxygen uptake indexation by fat free mass, these differences disappeared, suggesting a similar cardiovascular function. At the end of the exercise, the control group reached 96% of their age-predicted maximal heart rate and their respiratory exchange ratio was 1 0.2. Obese patients only reached 86% and 0.87 0.2, respectively. CONCLUSIONS: Due to their need of more energy output to move total body mass morbidly obese patients have a reduced exercise capacity. They finish the test having done a submaximal exercise. However, during this effort they show a normal cardiopulmonar capacity.

Función cardiopulmonar y capacidad de ejercicio en pacientes con obesidad mórbida / Cardiopulmonary function and exercise capacity in patients with morbid obesity

Introducción y objetivos. La repercusión de la obesidad sobre la función cardíaca es motivo de controversia. El propósito del presente estudio ha sido determinar la capacidad cardiopulmonar en pacientes con obesidad mórbida. Pacientes y método. Hemos realizado una ergoespirometría limitada por síntomas a 31 pacientes con obesidad mórbida (IMC 50 ñ 9 kg/m2) y a 30 individuos como grupo control (IMC 24 ñ 2 kg/m2). La función cardiovascular ha sido valorada mediante el pulso de oxígeno (consumo de oxígeno/frecuencia cardíaca).Resultados. No existían diferencias en edad, sexo y talla entre ambos grupos. Durante el esfuerzo, los sujetos obesos presentaron un consumo de oxígeno, frecuencia cardíaca, presión arterial sistólica y ventilación por minuto significativamente más elevados que el grupo control, con menor duración de la prueba (14 ñ 3 frente a 27 ñ 4 min; p < 0,001). Los valores de pulso de oxígeno fueron más altos en los pacientes obesos. Sin embargo, tras corregir el consumo de oxígeno por la masa magra, las diferencias en el pulso de O2 desaparecieron, demostrando una función cardiovascular similar. Al final del ejercicio, el grupo control alcanzó el 96 por ciento de su frecuencia cardíaca máxima teórica y su cociente respiratorio fue de 1 ñ 0,2. Los pacientes obesos sólo alcanzaron el 86 por ciento de la frecuencia cardíaca máxima teórica y su cociente respiratorio fue de 0,87 ñ 0,2.Conclusiones. Los pacientes con obesidad mórbida tienen una capacidad de trabajo reducida debido al gran consumo energético que realizan al mover su masa corporal. Finalizan la prueba habiendo realizado un esfuerzo submáximo. No obstante, durante este esfuerzo demuestran una capacidad cardiopulmonar normal (AU)

Isolated noncompaction left ventricular myocardium and polymorphic ventricular tachycardia.

A 57-year-old woman with syncope was admitted. She had a family history of sudden death: two brothers had died suddenly at the age of 47. Transesophageal echocardiography showed numerous prominent trabeculations and deep intertrabecular recesses in the anterior and lateroapical zones. Isotopic left ventricular ejection fraction was 46%. Cardiac catheterization showed coronary arteries with no angiographic lesions. A prominent trabecular zone and deep intertrabecular recesses were seen in the anterior wall on left ventriculography. Right ventriculography was normal. The diagnosis of isolated noncompaction left ventricular myocardium was established. Continuous 24-h electrocardiographic registry showed episodes of polymorphic ventricular tachycardia. Programmed ventricular stimulation performed at the right ventricular apex with up to three extrastimuli failed to induce ventricular arrhythmias. Treatment with beta blockers was initiated, but short runs of polymorphic ventricular tachycardia persisted. A dual-chamber automatic implantable defibrillator was implanted. We discuss the physiopathology of the arrhythmia. It appears that several factors could be responsible for the malignant arrhythmias in this entity.